HAAD exam: now the DOH Abu Dhabi exam

Results: Pass or Fail only - DOH does not share scores.

Attempts: Three attempts in total across DHA, DOH, MOHAP and SHA combined - not three each (Unified PQR, clause 1.5.5), and you must declare earlier attempts. DOH's own Standard for Licensing Examinations lets you re-sit 3 months after a failed attempt, and bars a re-sit for 12 months after a third failure. The PQR's 2024 update allows one further attempt with a different authority, except on the Consultant route.

1. Question 1Nursingmedium

   A patient with suspected pneumonia has a blood pressure of 82/48 mmHg and a lactate of 4.6 mmol/L. Blood cultures have been taken. Which fluid resuscitation do current sepsis guidelines suggest within the first 3 hours?

   1. AAt least 30 mL/kg of IV crystalloid
   2. B500 mL of 5% dextrose over 4 hours
   3. CIV albumin 20% as the first fluid
   4. DNo fluids until the chest X-ray is reported
   Show answer and explanation▾

   Answer: A. At least 30 mL/kg of IV crystalloid

   For sepsis with hypotension or a lactate of 4 mmol/L or more, guidelines suggest at least 30 mL/kg of IV crystalloid in the first 3 hours, with antibiotics within an hour, then reassessment. Dextrose is not a resuscitation fluid, and albumin is not the first choice.

   Reference: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock (2021)

2. Question 2Nursingeasy

   Before giving a blood transfusion, how should a nurse confirm the patient's identity?

   1. AAsk the patient's room number
   2. BUse at least two identifiers, such as full name and date of birth, checked against the wristband and the blood product
   3. CCheck the patient's bed number against the request form
   4. DAsk a colleague whether this is the right patient
   Show answer and explanation▾

   Answer: B. Use at least two identifiers, such as full name and date of birth, checked against the wristband and the blood product

   Safety standards require at least two patient-specific identifiers, such as name and date of birth or medical record number, matched to the wristband and the product. Room or bed numbers are never identifiers, because patients move.

   Reference: The Joint Commission National Patient Safety Goal NPSG.01.01.01

3. Question 3Nursingmedium

   A new nasogastric tube has been inserted for feeding. The aspirate pH is 6.5. What should the nurse do before starting the feed?

   1. AStart the feed, because the tube is in the stomach
   2. BConfirm placement with a chest X-ray before using the tube
   3. CCheck placement by listening for a 'whoosh' of injected air
   4. DFlush the tube with 50 mL of water and start the feed
   Show answer and explanation▾

   Answer: B. Confirm placement with a chest X-ray before using the tube

   An aspirate pH of 5.5 or below supports gastric placement. Above that, placement is not confirmed and an X-ray is needed before anything is put down the tube. The air 'whoosh' test is unreliable and should not be used, and flushing an unconfirmed tube risks putting fluid into the lungs.

   Reference: NHS Improvement Patient Safety Alert: Nasogastric Tube Misplacement (2016)

4. Question 4General Practicemedium

   A 54-year-old with type 2 diabetes has a blood pressure of 146/92 mmHg on repeated readings and a urine albumin-to-creatinine ratio of 45 mg/mmol (about 400 mg/g). Which antihypertensive class should be first line?

   1. AThiazide diuretic
   2. BACE inhibitor or angiotensin receptor blocker
   3. CBeta-blocker
   4. DAlpha-blocker
   Show answer and explanation▾

   Answer: B. ACE inhibitor or angiotensin receptor blocker

   With diabetes and albuminuria, an ACE inhibitor or ARB is first line, because it reduces albuminuria and slows progression of kidney disease, titrated to the maximum tolerated dose. Check potassium and creatinine within 2-4 weeks of starting.

   Reference: KDIGO Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022)

5. Question 5General Practiceeasy

   A 38-year-old woman has a microcytic, hypochromic anaemia. Which single blood test best confirms iron deficiency?

   1. ASerum ferritin
   2. BSerum iron alone
   3. CReticulocyte count
   4. DVitamin B12 level
   Show answer and explanation▾

   Answer: A. Serum ferritin

   A low serum ferritin is the most specific test for iron deficiency. Ferritin is an acute-phase protein, so a normal level does not exclude deficiency when there is inflammation. Serum iron fluctuates too much to be relied on alone, and B12 deficiency causes a macrocytic anaemia.

   Reference: British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults (2021)

6. Question 6General Practiceeasy

   A 19-year-old with no drug allergies has a sore throat, fever, tender anterior cervical nodes and tonsillar exudate, and a positive rapid strep test. What is the first-line treatment?

   1. APenicillin V or amoxicillin for 10 days
   2. BAzithromycin for 3 days
   3. CCiprofloxacin for 5 days
   4. DNo antibiotics in any case
   Show answer and explanation▾

   Answer: A. Penicillin V or amoxicillin for 10 days

   Confirmed group A streptococcal pharyngitis is treated with penicillin V or amoxicillin for 10 days, as resistance is not a problem and they are narrow-spectrum. Macrolides are for penicillin allergy, and fluoroquinolones are not appropriate.

   Reference: IDSA Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis (2012)

7. Question 7Pharmacymedium

   A patient on metformin 1 g twice daily now has an eGFR of 25 mL/min/1.73 m². What should the pharmacist recommend?

   1. AContinue the same dose
   2. BStop metformin
   3. CDouble the dose to maintain glucose control
   4. DSwitch to extended-release metformin at the same dose
   Show answer and explanation▾

   Answer: B. Stop metformin

   Metformin is contraindicated when eGFR is below 30 mL/min/1.73 m² because of the risk of lactic acidosis. Between 30 and 45 the dose is reviewed and starting it is not recommended. Extended-release metformin carries the same restriction.

   Reference: ADA Standards of Care in Diabetes: Pharmacologic Approaches to Glycemic Treatment (2024)

8. Question 8Pharmacyhard

   Before starting allopurinol, which genetic test is recommended for patients of Han Chinese, Thai or Korean descent to reduce the risk of severe cutaneous reactions such as SJS/TEN?

   1. AHLA-B*58:01
   2. BHLA-B*57:01
   3. CCYP2C19 genotype
   4. DTPMT activity
   Show answer and explanation▾

   Answer: A. HLA-B*58:01

   HLA-B*58:01 is strongly associated with allopurinol-induced SJS/TEN and DRESS and is common in Han Chinese, Thai and Korean people, so testing is recommended before treatment. HLA-B*57:01 predicts abacavir hypersensitivity, and TPMT guides thiopurine dosing.

   Reference: 2020 American College of Rheumatology Guideline for the Management of Gout

9. Question 9Dentistrymedium

   A patient with a prosthetic aortic valve needs an extraction. He has no penicillin allergy. Which antibiotic prophylaxis is recommended?

   1. AAmoxicillin 2 g orally, 30-60 minutes before the procedure
   2. BAmoxicillin 500 mg three times daily for 5 days after the procedure
   3. CMetronidazole 400 mg before the procedure
   4. DNo prophylaxis is ever needed for extractions
   Show answer and explanation▾

   Answer: A. Amoxicillin 2 g orally, 30-60 minutes before the procedure

   For high-risk patients, including those with prosthetic valves, having procedures that manipulate gingival tissue, a single dose of amoxicillin 2 g orally 30-60 minutes before is recommended. Post-operative courses are not used for prophylaxis, and metronidazole does not cover viridans streptococci.

   Reference: AHA Scientific Statement: Prevention of Viridans Group Streptococcal Infective Endocarditis (2021)

10. Question 10Dentistryeasy

    Three days after a lower molar extraction, a patient has severe throbbing pain radiating to the ear and bad breath. The socket is empty, with exposed bone and no swelling or fever. What is the most appropriate management?

    1. AIrrigate the socket and place a medicated dressing, with analgesia
    2. BPrescribe a 7-day course of amoxicillin alone
    3. CCurette the socket vigorously to induce fresh bleeding
    4. DIncise and drain
    Show answer and explanation▾

    Answer: A. Irrigate the socket and place a medicated dressing, with analgesia

    This is alveolar osteitis (dry socket). It is managed with gentle saline irrigation, an obtundent dressing and analgesics. It is not an infection, so antibiotics alone do not help, and aggressive curettage increases pain. There is no collection to drain.

    Reference: Hupp, Ellis and Tucker, Contemporary Oral and Maxillofacial Surgery, 7th ed. (2019)

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